Anterior cervical locking plate-related complications; prevention and treatment recommendations.
A retrospective study evaluating complications in 2,233 consecutive patients of subaxial cervical disorders treated with an anterior cervical locking plate was performed, and recommendations for prevention and treatment were made. The average length of follow-up was 1.3 years. Any loosening or breaking of the plates and screws or malpositions that threatened tracheoesophageal or neurovascular structures were defined as the complications. There were 239 cases (10.7%) with different kinds of complications. The complications included oblique plating in 56 cases in which the screw could irritate the nerve root. Screws were driven into the disc space in four cases, which ultimately led to plate loosening. Screws penetrated the endplate or passed excessively close to it producing a triangle fracture in 19 cases. Loosening or breaking of the plate and the screw was found in 115 cases. These phenomena were always associated with non-union. Three oesophageal perforations occurred and conservative treatments proved effective. Finally, overlong plates impinged on the adjacent level in 14 cases and promoted disc degeneration ultimately leading to revision surgery. Good training and careful operation may help to decrease the complication rate. Most hardware complications are not symptomatic and can be treated conservatively. Only a few of them need immediate reoperation. (+info)
Posterior atlantoaxial subluxation due to os odontoideum combined with cervical spondylotic myelopathy: a case report.
In patients with os odontoideum and posterior atlantoaxial subluxation are extremely rare. No reports have described posterior atlantoaxial subluxation associated with os odontoideum combined with cervical spondylotic canal stenosis, both of which require surgical treatment. We report one case of a 75-year-old female who underwent arthrodesis between the occiput and C3 using a hook-and-rod system and also a double-door laminoplasty from levels C3 to C7. The claw mechanism was applied between the C2 lamina and the C3 inferior articular process. The posterior atlantoaxial subluxation was completely reduced by the method that the rod gradually pushed the posterior arch of C1 anteriorly during connection to the occiput. Twelve months after surgery, the patient showed improvement in preoperative clumsiness and gait disturbance, and the latest plain radiographs showed solid osseous fusion, with no loss of correction or instrumentation failure. (+info)
Bilateral cervical spondylolysis in a young Chinese woman presenting with a neck injury.
Cervical spondylolysis is an uncommon entity. It is important to recognise its characteristic radiological features and differentiate it from acute cervical fractures or dislocations in patients with neck injuries. We report the relevant clinical and radiological findings seen in a young Chinese woman managed in our hospital after a neck injury who was ultimately diagnosed with bilateral cervical spondylolysis with spondylolisthesis at C6. (+info)
Surgical treatment of cervical spondylosis in the elderly: surgical outcomes, risk factors, and complications.
The incidence of cervical spondylosis in the elderly is increasing with the higher proportion of elderly individuals among the Japanese population. The present study retrospectively analyzed the clinical and radiological features of this clinical entity in 107 patients with cervical spondylosis aged 70 years or older surgically treated between 1995 and 2005. The patients were divided into Group 1 (n = 60) aged between 70 and 74 years, and Group 2 (n = 47) 75 years or older. Patients with localized compression within 2 levels responsible for the neurological symptoms underwent anterior fusion, and patients with a narrow spinal canal were treated by laminoplasty. The pre- and postoperative neurological status (Neurosurgical Cervical Spine Scale) and postoperative complications were compared. More patients in Group 2 required laminoplasty but most patients underwent single-level anterior fusion. There was no statistically significant difference in the surgical results. Group 2 had a much higher ratio of anterior fusion at the C3-4 level. Many of the aged patients had multiple risk factors. Surgical decompression for cervical spondylosis is beneficial even in elderly patients. Single-level anterior fusion to treat the lesion most responsible for the symptoms is the least invasive choice. Elderly patients tend to present with multiple risk factors so require careful perioperative management. (+info)
Percutaneous cervical nucleoplasty in the treatment of cervical disc herniation.